Risk Factors for Return Visits to the Pediatric Emergency Department: Systematic Search and Review

Risk Factors for Return Visits to the Pediatric Emergency Department


  • Chady El Tawil Division of Pediatric Emergency Medicine, Department of Pediatrics, Montreal Children's Hospital, McGill University Health Centre, Montreal, Canada https://orcid.org/0000-0002-3379-9803
  • Imane Chedid Pediatric Emergency Department, Children’s Hospital of Richmond – Virginia Commonwealth University Health System, Virginia, USA
  • Amy Bergeron McGill University Health Centre Medical Libraries, Montreal, Quebec, Canada
  • Isabelle Gagnon Division of Pediatric Emergency Medicine, Department of Pediatrics, Montreal Children's Hospital, McGill University Health Centre, Montreal, Canada
  • Ilana Greenstone



Return visits (RVs) to the emergency department (ED) has always been a major concern. RVs to the emergency department are a big burden on the healthcare system as its cost is higher than the cost of the initial visit. This review was performed to identify factors associated with risk of RVs to the pediatric ED.


Methods and Analysis

One researcher searched Medline, Embase, Cochrane Library and Web of Science. Studies were identified by using MeSH and keywords and included RVs to the pediatric ED up to 1 year a primary outcome. All studies were screened by two independent reviewers for eligibility and in case of disagreement, a meeting was held to discuss the problematic studies and a consensus was achieved.



The search identified 539 reports from which 28 articles were included. Data was then extracted from the included studies according to a preset format. The exposures were grouped in 3 different groups: very probable, possible, and less likely.

As a result, young age, language barrier and high acuity were identified as very probable risk factors. Having a public insurance or with low income, patients with comorbidities and patients who had multiple previous ED visits were found to be possible risk factors for return visits.



Young age, high acuity and language barrier among others are risk factors for return visits to the pediatric ED. Physicians should be aware of these factors and have a low threshold for admission or a good discharge plan for patients with one or more factors.

Author Biographies

Chady El Tawil, Division of Pediatric Emergency Medicine, Department of Pediatrics, Montreal Children's Hospital, McGill University Health Centre, Montreal, Canada

Pediatric Emergency Medicine Fellow

Imane Chedid, Pediatric Emergency Department, Children’s Hospital of Richmond – Virginia Commonwealth University Health System, Virginia, USA

Pediatric Emergency Medicine Fellow

Isabelle Gagnon, Division of Pediatric Emergency Medicine, Department of Pediatrics, Montreal Children's Hospital, McGill University Health Centre, Montreal, Canada


Ilana Greenstone

Pediatric Emergency Physician


Lerman B, Kobernick MS. Return visits to the emergency department. J Emerg Med. 1987 Sep-Oct;5(5):359-62. doi: 10.1016/0736-4679(87)90138-7. PMID: 3668198.

Duseja R, Bardach NS, Lin GA, Yazdany J, Dean ML, Clay TH, Boscardin WJ, Dudley RA. Revisit rates and associated costs after an emergency department encounter: a multistate analysis. Ann Intern Med. 2015 Jun 2;162(11):750-6. doi: 10.7326/M14-1616. PMID: 26030633.

Chiang CY, Cheng FJ, Huang YS, Chen YL, Wu KH, Chiu IM. ICU admission following an unscheduled return visit to the pediatric emergency department within 72 hours. BMC Pediatr. 2019;19(1):268. https://doi.org/10.1186/s12887-019-1644-y

Ostrow O, Zelinka A, Shim A, Azmat SK, Masood S, Chartier LB. Pediatric Emergency Department Return Visits: An Innovative and Systematic Approach to Promote Quality Improvement and Patient Safety. Pediatr Emerg Care. 2020 Dec;36(12):e726-e731. doi: 10.1097/PEC.0000000000001999. PMID: 31977769

Ko M, Lee Y, Chen C, Chou P, Chu D. Incidence of and Predictors for Early Return Visits to the Emergency Department: A Population-Based Survey. Medicine (Baltimore). 2015 Oct;94(43):e1770. doi: 10.1097/MD.0000000000001770. PMID: 26512573; PMCID: PMC4985387.

Benbassat J, Taragin M. Hospital readmissions as a measure of quality of health care: advantages and limitations. Arch Intern Med. 2000 Apr 24;160(8):1074-81. doi: 10.1001/archinte.160.8.1074. PMID: 10789599.

Trivedy CR, Cooke MW. Unscheduled return visits (URV) in adults to the emergency department (ED): a rapid evidence assessment policy review. Emerg Med J. 2015 Apr;32(4):324-9. doi: 10.1136/emermed-2013-202719. Epub 2013 Oct 28. PMID: 24165201.

Tran QK, Bayram JD, Boonyasai RT, Case MA, Connor C, Doggett D, Fawole OA, Ijagbemi OM, Levin S, Wu AW, Pham JC. Pediatric Emergency Department Return: A Literature Review of Risk Factors and Interventions. Pediatr Emerg Care. 2016 Aug;32(8):570-7. doi: 10.1097/PEC.0000000000000876. PMID: 27490736.

Aaronson E, Jansson P, Wittbold K, Flavin S, Borczuk P. Unscheduled return visits to the emergency department with ICU admission: A trigger tool for diagnostic error. Am J Emerg Med. 2020 Aug;38(8):1584-1587. doi: 10.1016/j.ajem.2019.158430. Epub 2019 Sep 6. PMID: 31699427.

Ehwerhemuepha L, Yu PT, Guner YS, Wallace E, Feaster W. A Nested Mixed Effects Multicenter Model Examining the Risk Factors for Pediatric Trauma Return Visits Within 72 Hours. J Surg Res. 2021 Jan;257:370-378. doi: 10.1016/j.jss.2020.08.021. Epub 2020 Sep 3. PMID: 32892133.

Pershad J, Jones T, Harrell C, Ajayi S, Giles K, Cross C, Huang E. Factors Associated With Return Visits at 7 Days After Hospital Discharge. Hosp Pediatr. 2020 Apr;10(4):353-358. doi: 10.1542/hpeds.2019-0207. Epub 2020 Mar 13. PMID: 32169994.

Türe E, Yazar A. Retrospective Evaluation of Return Visits to the Paediatric Emergency Department. Eurasian J Emerg Med. 2020;19(2):115-20 DOI:10.4274/eajem.galenos.2019.68926

Drouin O, D'Angelo A, Gravel J. Impact of wait time during a first pediatric emergency room visit on likelihood of revisit in the next year. Am J Emerg Med. 2020 May;38(5):890-894. doi: 10.1016/j.ajem.2019.07.005. Epub 2019 Jul 3. PMID: 31300177.

Daymont C, Balamuth F, Scott HF, Bonafide CP, Brady PW, Depinet H, Alpern ER. Elevated Heart Rate and Risk of Revisit With Admission in Pediatric Emergency Patients. Pediatr Emerg Care. 2021 Apr 1;37(4):e185-e191. doi: 10.1097/PEC.0000000000001552. PMID: 30020247; PMCID: PMC6335199.

de Vos-Kerkhof E, Geurts DHF, Steyerberg EW, Lakhanpaul M, Moll HA, Oostenbrink R. Characteristics of revisits of children at risk for serious infections in pediatric emergency care. Eur J Pediatr. 2018 Apr;177(4):617-624. doi: 10.1007/s00431-018-3095-0. Epub 2018 Feb 3. PMID: 29397418; PMCID: PMC5851682.

Kim BS, Kim JY, Choi SH, Yoon YH. Understanding the characteristics of recurrent visits to the emergency department by paediatric patients: a retrospective observational study conducted at three tertiary hospitals in Korea. BMJ Open. 2018 Feb 16;8(2):e018208. doi: 10.1136/bmjopen-2017-018208. PMID: 29453296; PMCID: PMC5857697.

Michelson KA, Lyons TW, Bachur RG, Monuteaux MC, Finkelstein JA. Timing and Location of Emergency Department Revisits. Pediatrics. 2018 May;141(5):e20174087. doi: 10.1542/peds.2017-4087. Epub 2018 Apr 12. PMID: 29650806.

Meyer-Macaulay CB, Truong M, Meckler GD, Doan QH. Return visits to the pediatric emergency department: A multicentre retrospective cohort study. CJEM. 2018 Jul;20(4):578-585. doi: 10.1017/cem.2017.40. Epub 2017 Jun 19. PMID: 28625173.

Ruttan T, Lawson KA, Piper K, Wilkinson M. Risk Factors Associated With Emergency Department Return Visits Following Trauma System Discharge. Pediatr Emerg Care. 2018 Mar;34(3):202-207. doi: 10.1097/PEC.0000000000001182. PMID: 28590991.

Hu YH, Tai CT, Chen SC, Lee HW, Sung SF. Predicting return visits to the emergency department for pediatric patients: Applying supervised learning techniques to the Taiwan National Health Insurance Research Database. Comput Methods Programs Biomed. 2017 Jun;144:105-112. doi: 10.1016/j.cmpb.2017.03.022. Epub 2017 Mar 25. PMID: 28494994.

Kilicaslan O, Sönmez FT, Gunes H, Temizkan RC, Kocabay K, Saritas A. Short Term Unscheduled Revisits to Paediatric Emergency Department - A Six Year Data. J Clin Diagn Res. 2017 Mar;11(3):SC12-SC15. doi: 10.7860/JCDR/2017/25098.9484. Epub 2017 Mar 1. PMID: 28511472; PMCID: PMC5427398.

Samuels-Kalow ME, Stack AM, Amico K, Porter SC. Parental Language and Return Visits to the Emergency Department After Discharge. Pediatr Emerg Care. 2017 Jun;33(6):402-404. doi: 10.1097/PEC.0000000000000592. PMID: 26569079.

Wilson PM, Florin TA, Huang G, Fenchel M, Mittiga MR. Is Tachycardia at Discharge From the Pediatric Emergency Department a Cause for Concern? A Nonconcurrent Cohort Study. Ann Emerg Med. 2017 Sep;70(3):268-276.e2. doi: 10.1016/j.annemergmed.2016.12.010. Epub 2017 Feb 24. PMID: 28238501.

Goh GL, Huang P, Kong MC, Chew SP, Ganapathy S. Unplanned reattendances at the paediatric emergency department within 72 hours: a one-year experience in KKH. Singapore Med J. 2016 Jun;57(6):307-13. doi: 10.11622/smedj.2016105. PMID: 27353384; PMCID: PMC4971449.

Schneider M, Chen C, Menoch M, Levasseur K. Primary language and return visits in the pediatric emergency department. SAEM Annual Meeting Abstracts. Acad Emerg Med. 2016 Jun [Cited 2023 December 1], 23:S103-S104. Available from: https://onlinelibrary.wiley.com/doi/epdf/10.1111/acem.12974

de Vos-Kerkhof E, Geurts DH, Wiggers M, Moll HA, Oostenbrink R. Tools for 'safety netting' in common paediatric illnesses: a systematic review in emergency care. Arch Dis Child. 2016 Feb;101(2):131-9. doi: 10.1136/archdischild-2014-306953. Epub 2015 Jul 10. PMID: 26163122.

Saunders N, To T, Parkin P, Guttmann A. The relationship between immigrant status and pediatric emergency department return visits. Paediatrics and Child Health (Canada). 2015;20:e93. DOI:10.1093/pch/20.5.e93

Sung SF, Liu KE, Chen SC, Lo CL, Lin KC, Hu YH. Predicting Factors and Risk Stratification for Return Visits to the Emergency Department Within 72 Hours in Pediatric Patients. Pediatr Emerg Care. 2015 Dec;31(12):819-24. doi: 10.1097/PEC.0000000000000417. PMID: 25875996.

Gallagher RA, Porter S, Monuteaux MC, Stack AM. Unscheduled return visits to the emergency department: the impact of language. Pediatr Emerg Care. 2013 May;29(5):579-83. doi: 10.1097/PEC.0b013e31828e62f4. PMID: 23603647.

Samuels-Kalow ME, Stack AM, Amico K, Porter SC. The association between parental language and 72-hour revisits following pediatric emergency department discharge. SAEM Annual Meeting Abstracts. Acad Emerg Med. 2013 Apr [cited 2023 Dec 1], 20 (5):S188. Available from: https://onlinelibrary.wiley.com/doi/epdf/10.1111/acem.12115

Gaucher N, Bailey B, Gravel J. Impact of physicians' characteristics on the admission risk among children visiting a pediatric emergency department. Pediatr Emerg Care. 2012 Feb;28(2):120-4. doi: 10.1097/PEC.0b013e318243f8e0. PMID: 22270494.

Reinke DA, Walker M, Boslaugh S, Hodge D 3rd. Predictors of pediatric emergency patients discharged against medical advice. Clin Pediatr (Phila). 2009 Apr;48(3):263-70. doi: 10.1177/0009922808323109. Epub 2008 Oct 2. PMID: 18832530.

Costabel S, Piccotti E, Sartini M, Magnani M, Di Pietro P. Return visits to the Paediatric Emergency Department: first analysis in Italy. J Prev Med Hyg. 2008 Dec;49(4):142-7. PMID: 19350962.

Goldman RD, Ong M, Macpherson A. Unscheduled return visits to the pediatric emergency department-one-year experience. Pediatr Emerg Care. 2006 Aug;22(8):545-9. doi: 10.1097/01.pec.0000230553.01917.05. PMID: 16912620.

LeDuc K, Rosebrook H, Rannie M, Gao D. Pediatric emergency department recidivism: demographic characteristics and diagnostic predictors. J Emerg Nurs. 2006 Apr;32(2):131-8. doi: 10.1016/j.jen.2005.11.005. PMID: 16580475.

Alessandrini EA, Lavelle JM, Grenfell SM, Jacobstein CR, Shaw KN. Return visits to a pediatric emergency department. Pediatr Emerg Care. 2004 Mar;20(3):166-171. doi: 10.1097/01.pec.0000117924.65522.a1. PMID: 15094574.

Navanandan N, Schmidt SK, Cabrera N, Topoz I, DiStefano MC, Mistry RD. Seventy-two-hour Return Initiative: Improving Emergency Department Discharge to Decrease Returns. Pediatr Qual Saf. 2020 Sep 25;5(5):e342. doi: 10.1097/pq9.0000000000000342. PMID: 34616961; PMCID: PMC8487775.

Hampers LC, Cha S, Gutglass DJ, Binns HJ, Krug SE. Language barriers and resource utilization in a pediatric emergency department. Pediatrics. 1999 Jun;103(6 Pt 1):1253-6. doi: 10.1542/peds.103.6.1253. PMID: 10353938.

Zamor R, Byczkowski T, Zhang Y, Vaughn L, Mahabee-Gittens EM. Language Barriers and the Management of Bronchiolitis in a Pediatric Emergency Department. Acad Pediatr. 2020 Apr;20(3):356-363. doi: 10.1016/j.acap.2020.01.006. Epub 2020 Jan 22. PMID: 31981655; PMCID: PMC7102638.

Hampers LC, McNulty JE. Professional interpreters and bilingual physicians in a pediatric emergency department: effect on resource utilization. Arch Pediatr Adolesc Med. 2002 Nov;156(11):1108-13. doi: 10.1001/archpedi.156.11.1108. PMID: 12413338.

Doan Q, Wong H, Meckler G, Johnson D, Stang A, Dixon A, Sawyer S, Principi T, Kam AJ, Joubert G, Gravel J, Jabbour M, Guttmann A; for Pediatric Emergency Research Canada (PERC). The impact of pediatric emergency department crowding on patient and health care system outcomes: a multicentre cohort study. CMAJ. 2019 Jun 10;191(23):E627-E635. doi: 10.1503/cmaj.181426. PMID: 31182457; PMCID: PMC6565395.

Al-Qahtani, M.H., Yousef, A.A., Awary, B.H. et al. Characteristics of visits and predictors of admission from a paediatric emergency room in Saudi Arabia. BMC Emerg Med 21, 72 (2021). https://doi.org/10.1186/s12873-021-00467-7

Grant MJ, Booth A. A typology of reviews: an analysis of 14 review types and associated methodologies. Health Info Libr J. 2009 Jun;26(2):91-108. doi: 10.1111/j.1471-1842.2009.00848.x. PMID: 19490148.




How to Cite

El Tawil, C., Chedid, I., Bergeron, A., Gagnon, I., & Greenstone, I. (2023). Risk Factors for Return Visits to the Pediatric Emergency Department: Systematic Search and Review: Risk Factors for Return Visits to the Pediatric Emergency Department. Panorama of Emergency Medicine, 1(1). Retrieved from https://panoramaoem.com/index.php/poem/article/view/4